Priti Khare
Research Mentor(s): Alvaro Rojas-Peña
Mentor Department: Department of Surgery-Transplantation
Authors: Priti Khare, Jensyn VanZalen, Temilolaoluwa Daramola, Daniela Pelaez Palacio, Ryan Kauffman, Gergely Lautner, Orsolya Lautner-Csorba, Robert Bartlett, Alvaro Rojas-Pena
Session: Session 1 (9:00am – 9:50am)
Presentation Type: Poster 45
Abstract
Introduction: Systemic anticoagulation during extracorporeal membrane oxygenation (ECMO) is essential to prevent thrombosis caused by the interaction between blood and artificial surfaces. However, this approach carries a risk of hemorrhagic complications. Our research team has proposed the use of localized nitric oxide (NO) as an alternative to systemic anticoagulation. This study aims to evaluate the systemic effects of localized NO anticoagulation in an ovine model of venovenous (VV) ECMO over a 14-day period. Methodology: Ten sheep (40-50 kg) were anesthetized, instrumented for VV ECMO, and divided into three groups: 1) Control group (n=4): ECMO with systemic heparinization; 2) NO-gas group: ECMO with 100 ppm NO infused in the sweep gas (n=3); and 3) NO-releasing circuit (n=3): ECMO with NO-releasing circuit plus 100 ppm NO infused in the sweep gas. Animals were observed for up to14 days or until reaching end-point criteria, clarified as: a) device resistance 5x baseline; b) >50% decrease of ECMO blood flow after adjusting RPMs; c) post-oxygenator sO2% <95%; and d) animal hemodynamic instability or distress (termination required two criteria). ECMO flow was 1.2 L/min throughout the study. Data analyzed included: mean arterial pressures (MAP), heart rate (HR), respiratory rate (RR), white blood cell count (WBC), and NO toxicity. Results: The average circuit patency across the study was 124.6±59.3, 215.5±128.7, and 312.3±41 hrs for the control, NO-gas, and NO-releasing circuit groups, respectively. The average MAP across the study was 105.2±7.4, 104±9, and 103.4±8 mmHg for the control, NO-gas, and NO-releasing circuit groups, respectively. HR and RR were maintained within normal physiological parameters without differences between groups. The average overall WBC across the study was 12.8±3.2, 8.7±1.7, and 11.0±1.3 k/µL for the control, NO-gas, and NO-releasing circuit, respectively. The average WBC at the end of the study was 13.1±2.6, 8.5±3, and 9.9±0.9 k/µL for the control, NO-gas, and NO-releasing circuit, respectively. Furthermore, methemoglobin, a surrogate of NO toxicity remained <5% throughout the study for the NO groups. Conclusion: Preliminary findings suggest that the NO a reduces inflammation and stabilizes hemodynamics with prolonged circuit survival compared to the heparinized control circuit. However, the final results of this study are currently pending. This research has significant implications for reducing morbidity and mortality in ECLS by proposing a safer, more effective anticoagulant.
